Provider Demographics
NPI:1780900399
Name:DOUGHERTY, RYAN ANDREW (CPO)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:ANDREW
Last Name:DOUGHERTY
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 N COLUMBIA ST STE F
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-7166
Mailing Address - Country:US
Mailing Address - Phone:706-389-1260
Mailing Address - Fax:706-786-0797
Practice Address - Street 1:1820 N COLUMBIA ST STE F
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-7166
Practice Address - Country:US
Practice Address - Phone:706-389-1260
Practice Address - Fax:706-786-0797
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA158224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist